NPIMap

Organization Active NPI

Northeastern Vermont Regional Hospital, Inc

Doing business as NVRH Womens Wellness Center

  • Rural Health Clinic/Center
  • St Johnsbury, VT
National Provider Identifier
1831132299
Registry record updated Feb 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Doing business as
NVRH Womens Wellness Center
Practice address
1315 Hospital Dr
St Johnsbury, VT 05819-9210
Phone
(802) 748-7300
Fax
(802) 748-7321
NPI assigned
Jun 14, 2006
Last updated
Feb 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert N Hersey
Title
Cfo
Phone
(802) 748-7520

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1315 Hospital Dr
St Johnsbury, VT 05819-9210

Mailing address

PO Box 905
St Johnsbury, VT 05819-0905
Phone (802) 748-8141

Other names 1

  • NVRH Womens Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060324000349 VT Part B Supplier - Clinic/Group Practice 3678481405 Receives reassigned benefits from 22 practitioners
Practice locations: Saint Johnsbury, VT
O20130823000063 VT Part A Provider - Rural Health Clinic 3678481405 Practice locations: Saint Johnsbury, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831132299. Details of each certification follow.

Rural health clinic certification: CCN 473992

Legal name
NORTHEASTERN VERMONT REGIONAL HOSPITAL INC
Doing business as
NVRH WOMENS WELLNESS CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 4, 2014
Last certification
Apr 4, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1964 in VT
Enrollment address
1315 Hospital Dr
Saint Johnsbury, VT 05819-9210
Related CCNs
471303

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Robert N Hersey Individual Corporate OfficerCfo Oct 1, 1999
W-2 Managing Employee Sep 1, 1999
Shawn Patrick Tester Individual Corporate OfficerCeo Dec 31, 2018
W-2 Managing EmployeeCeo Dec 31, 2018
Andre Bissonnette Individual Corporate OfficerChief Financial Officer Jul 15, 2022

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1831132299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 905",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058190905",
            "telephone_number": "802-748-8141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 HOSPITAL DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199210",
            "telephone_number": "802-748-7300",
            "fax_number": "802-748-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "HERSEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "802-748-7520"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NVRH Womens Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NVRH Womens Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Johnsbury, VT

Sources for this page

Verify at the official NPI Registry.